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1.
Am J Otolaryngol ; 42(6): 103162, 2021.
Article in English | MEDLINE | ID: covidwho-1321975

ABSTRACT

OBJECTIVE: Restriction in healthcare services during the COVID-19 pandemic caused delays in the diagnosis and treatment of several diseases. To overcome the risk of missed diagnosis of head and neck cancers, before deleting the scheduled appointments, we have introduced a selection of the patients by examining the clinical presenting issue and previous medical history. The aim of this study is to show the effects of the abovementioned strategy on the diagnosis and management of laryngeal cancer. METHODS: Data were extracted from the Hospital software regarding the new diagnosis of laryngeal SCC in the periods from March 2020 to December 2020 during the pandemic (study group) and from March 2019 to December 2019 (control group) were collected. Data were compared regarding: TNM stage, time from first medical examination to histological diagnosis (Time-1), and time form histological diagnosis to beginning of treatments (Time-2). RESULTS: The final study group was composed by 19 laryngeal cancers, the control group by 25 cases. No significant differences were found in the tumour stage between the groups. In the study group, Time-1 was shorter (24 days versus 43 days, p = 0.012), while Time-2 in surgically-treated patients was longer (20 days versus 9 days, p = 0.012). CONCLUSION: During the pandemic, there was a dramatic lack of medical and nurse staff needed for surgical procedures. As consequence, the time between the diagnosis of malignancy and surgical treatment increased. In our unit, an efficient patient selection strategy to reschedule medical appointments avoided a dangerous shift toward higher laryngeal cancer stages.


Subject(s)
COVID-19 , Delayed Diagnosis/prevention & control , Delivery of Health Care/statistics & numerical data , Laryngeal Neoplasms/diagnosis , Laryngeal Neoplasms/prevention & control , Aged , Appointments and Schedules , Female , Humans , Laryngeal Neoplasms/pathology , Laryngeal Neoplasms/surgery , Male , Middle Aged , Neoplasm Staging , Time Factors
2.
Ear Nose Throat J ; 100(2_suppl): 113S-115S, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-655415

ABSTRACT

Acute airway obstruction caused by invasive laryngeal cancer can make surgeons reluctant to perform a high-risk tracheostomy, which is life-saving for such patients. In the setting of the current COVID19 pandemic, we present a case of severe transglottic stenosis due to stage IV laryngeal carcinoma, in which gaseous exchange was facilitated by venovenous (VV) extracorporeal membrane oxygenation prior to emergent tracheostomy. The VV technique can ensure adequate oxygenation and CO2 removal. Venovenous extracorporeal membrane oxygenation provided sufficient time for surgical planning and preparation. It reduced the formation of aerosol, lowered the risk associated with life-saving tracheostomy, and protected the patient from ischemia.


Subject(s)
Airway Obstruction/surgery , Extracorporeal Membrane Oxygenation/methods , Laryngeal Neoplasms/diagnosis , Perioperative Care/methods , Squamous Cell Carcinoma of Head and Neck/diagnosis , Tracheostomy/methods , Acute Disease , Aged , Airway Obstruction/etiology , COVID-19 , Emergencies , Humans , Laryngeal Neoplasms/complications , Laryngeal Neoplasms/pathology , Laryngoscopy , Male , Neoplasm Staging , SARS-CoV-2 , Squamous Cell Carcinoma of Head and Neck/complications , Squamous Cell Carcinoma of Head and Neck/pathology , Tomography, X-Ray Computed
3.
J Laryngol Otol ; 134(8): 747-749, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-611434

ABSTRACT

OBJECTIVE: To report our experience of diagnosis, investigation and management in patients who had undergone laryngectomy secondary to previous squamous cell carcinoma, who were subsequently infected with severe acute respiratory syndrome coronavirus-2 during the coronavirus disease 2019 pandemic. CASE REPORTS: Four post-laryngectomy patients with laboratory-proven severe acute respiratory syndrome coronavirus-2 infection were admitted to our institution from 1 March to 1 May 2020. All patients displayed symptoms of coronavirus disease 2019 and underwent investigations, including swab and serum sampling, and chest X-ray where indicated. All were managed conservatively on dedicated coronavirus disease 2019 wards and were discharged without the requirement of higher level care. CONCLUSION: It is hypothesised that laryngectomy may offer a protective effect against severe or critical disease in severe acute respiratory syndrome coronavirus-2 infection. We hope sharing our experience will aid all practitioners in the management of this, often intimidating, cohort of patients.


Subject(s)
Carcinoma, Squamous Cell/surgery , Coronavirus Infections/diagnosis , Laryngeal Neoplasms/pathology , Laryngectomy/adverse effects , Pneumonia, Viral/diagnosis , Aged , Betacoronavirus/isolation & purification , COVID-19 , Conservative Treatment/methods , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Coronavirus Infections/virology , Female , Humans , Laryngectomy/methods , Male , Middle Aged , Neoplasm Staging , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Pneumonia, Viral/virology , Postoperative Complications/virology , SARS-CoV-2 , Treatment Outcome
4.
Head Neck ; 42(6): 1131-1136, 2020 06.
Article in English | MEDLINE | ID: covidwho-66373

ABSTRACT

BACKGROUND AND METHODS: There is an added level of complexity in the management of head and neck cancer patients with underlying immunosuppressive disorders during the COVID-19 pandemic. Head and neck oncologists are tasked with balancing the dual risks of cancer progression in the setting of impaired tumor immunity and increased susceptibility to life-threatening complications from exposure to viral infection for patients and providers. Through two cases of immunocompromised patients with newly diagnosed head and neck malignancies, we aim to provide guidance to clinicians struggling with how to best counsel and manage this unique subset of patients under these difficult circumstances. RESULTS: After careful consideration of the options, we took different approaches in the care of these two patients. CONCLUSIONS: Ultimately, there is no uniform set of rules to apply to this heterogeneous group of immunocompromised patients. We provide some general principles to help guide patient management during the current pandemic.


Subject(s)
Conservative Treatment/methods , Coronavirus Infections/epidemiology , Head and Neck Neoplasms/therapy , Immunocompromised Host , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Time-to-Treatment/organization & administration , Adult , COVID-19 , Clinical Decision-Making , Communicable Disease Control/methods , Disease Management , Female , Follow-Up Studies , Head and Neck Neoplasms/pathology , Humans , Interdisciplinary Communication , Laryngeal Neoplasms/pathology , Laryngeal Neoplasms/surgery , Male , Middle Aged , Mouth Neoplasms/pathology , Mouth Neoplasms/surgery , Patient Safety , Risk Assessment , Sampling Studies , Time Factors , United States , Vocal Cords/pathology , Vocal Cords/surgery
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